Yasuyuki Naitoh

Nicardipine vs. Saline Injection as Treatment for Peyronie's Disease: A Prospective, Randomized, Single-Blind Trial

INTRODUCTION Various conservative treatments for Peyronies disease (PD) have been attempted over the years. Intralesional verapamil injection has been tested in prospective randomized studies, but the effect of this treatment seems insufficient. Nicardipine is a calcium antagonist alternative to verapamil and is reportedly more effective in vitro. AIM The objective of our study was to evaluate the usefulness of intralesional nicardipine injection as a conservative treatment for PD in the transition period of acute and chronic phase. METHODS Eighty-six patients (age: 38-72 years, mean: 52) were enrolled in this study. A total of 74 patients were assigned randomly to nicardipine group (10 mg diluted in 10 mL of distilled water daily, N=37) and control group (10 mL of saline water, N=37). A total of six injections were administrated biweekly. MEAN OUTCOME MEASURE The subjects were assessed by International Index of Erectile Function (IIEF)-5 and international pain scale. The plaque size was measured by ultrasonography after 20 µg intracavernosal injection of alprostadil (prostaglandin E1). The penile curvature was also measured by taking a photograph at maximum rigidity. RESULTS A reduction of pain score was seen throughout the course of treatment in both groups with a significant difference between the nicardipine and control groups (multiple analysis of variance test, P=0.019). A significant improvement of IIEF-5 score occurred only in the nicardipine group at 48 weeks after the initiation of treatment (P<0.01). The plaque size was significantly reduced at 48 weeks only in the nicardipine group (12 points, P=0.0004 by paired t-test). The penile curvature was significantly improved in both groups (P<0.01) without significant difference between them (P=0.14). There were no severe side effects, such as hypotension or other cardiovascular events. CONCLUSION Our findings indicate that intralesional nicardipine injection is clinically effective as a conservative treatment for PD in the transition period of acute and chronic phase.

Urological management of cloacal anomalies.

A cloacal anomaly results from incomplete urorectal division and is frequently associated with genitourinary abnormalities. Experience of the urological reconstruction of this entity is reported.

Transvesical laparoscopic cross-trigonal ureteral reimplantation for correction of vesicoureteral reflux: initial experience and comparisons between adult and pediatric cases.

PURPOSE Transvesical laparoscopic cross-trigonal ureteral reimplantation (TLCUR) has been reported as an alternative procedure for vesicoureteral reflux mainly in pediatric cases. We review our initial experience with TLCUR and evaluate its feasibility in adult patients. PATIENTS AND METHODS We performed TLCUR in 30 patients (22 females and 24 bilateral cases) with a median age of 14.5 years. RESULTS The median operating time was 145 minutes in the unilateral cases and 230 minutes in the bilateral cases. Blood loss was minimal in all cases. No intraoperative complications were observed. The urethral catheter was removed at day 2 to 3. One persistence of reflux and one uretero-vesico anastomosis stricture were observed. The total success rate of 49 ureters in 27 patients, in whom postoperative cystography was performed, was 96% (47/49). Comparing the first 15 and last 15 cases, patient age was similar, the operation time was significantly shorter in the last 15 cases, and both operative failures were found in the first 15 cases. Comparing the 15 pediatric and 15 adult cases, the operation time did not differ between the two groups and one operative failure was observed in each group. CONCLUSION This procedure was an effective and safe alternative minimally invasive procedure for both adult and pediatric patients with reflux.

CDK1 and CDK2 activity is a strong predictor of renal cell carcinoma recurrence

BACKGROUND In renal cell carcinoma (RCC), the prediction of metastasis via tumor prognostic markers remains a major problem. The objective of our study was to evaluate the efficacy of cyclin-dependent kinase (CDK)1 and CDK2 activity as a prognostic marker in human RCC. METHODS Surgical specimens were obtained from 125 patients with RCC without metastasis. Protein expression and kinase activity of CDKs were analyzed using a newly developed assay system named C2P (Sysmex, Kobe, Japan). We then examined the specific activities (SAs) of CDK1 and CDK2 and calculated CDK2SA-CDK1SA ratio in RCC. Also, risk score (RS) was examined. RESULTS A total of 125 cases were tested, though 34 cases were excluded because of low sample quality (25 cases) and assay failure (9 cases). In total, 91 cases were analyzed. They included 68 male and 23 female patients, ranging in age from 19 to 83 years. At a median follow-up of 36 months (1-109M), tumor with low CDK2SA-CDK1SA ratio showed significantly better 5-year recurrence-free survival than those with high CDK2SA-CDK1SA ratio (88.7% vs. 54.7%, P = 0.00141). Also, RS enabled the classification of RCCs into high-risk and low-risk groups, and patients with tumors classified as low RS showed better recurrence-free survival than patients with tumors with high RS (88.7% vs. 54.7%, P = 0.0141). CONCLUSION CDK1SA of tumors and the CDK2SA are both associated with recurrence and prognosis. IMPACT CDK-based risk demonstrated is strongly associated with clinical outcome. CDK-based risk should be an accurate system for predicting recurrence and survival for planning follow-up.

A Comparison of Cooling Methods for Laparoscopic Partial Nephrectomy

OBJECTIVES To evaluate appropriate cooling methods in laparoscopic partial nephrectomy. METHODS Under general anesthesia, 21 porcine kidneys were exposed retroperitoneoscopically. Ice slush (500 g) was put into the retroperitoneal cavity after renal vascular clamping. Renal parenchymal temperature was measured by a thermometer. Seven kidneys were cooled only by ice slush (group I). In seven kidneys, 200 mL of 4 degrees C saline was infused around the kidney 45 minutes after vascular clamping (group II). In seven kidneys, 4 degrees C saline was irrigated continuously through a 5F ureteral catheter, which was inserted into the ureter (group III). RESULTS In group I, 21 minutes after vascular clamping, the lowest temperature achieved was 13.2 degrees C, and at 47 minutes the temperature exceeded 20 degrees C. In group II, the lowest temperature achieved was 13.0 degrees C 23 minutes after vascular clamping, and at 59 minutes the temperature exceeded 20 degrees C. In group III, the lowest temperature of 10.6 degrees C was achieved at 27 minutes, and at 79 minutes the temperature exceeded 20 degrees C. CONCLUSIONS In complicated cases of laparoscopic partial nephrectomy, cooling with both ice slush and ureteral catheter irrigation was thought to be effective. When the renal collecting system is opened, an additional infusion of cooled water may also be effective.

Laparoendoscopic single‐site urological surgery: Initial experience in Japan

The objective of this paper is to report our initial experience in laparoendoscopic single‐site surgery (LESS). One patient underwent LESS varicocelectomy and another patient underwent LESS pyeloplasty. The Triport was inserted into the abdomen through the umbilical incision. In the varicocelectomy, testicular vessels were coagulated by a vessel‐sealing system, and transected. In the pyeloplasty, a 2‐mm needlescopic port was added to facilitate the procedure, and a dismembered procedure was performed. Total operative duration was 60 min for the varicocelectomy and 240 min for the pyeloplasty. Blood loss was minimal and no perioperative complications occurred. At the 3‐month follow up, no postoperative complications were observed and there was no complaint of pain. LESS varicocelectomy and pyeloplasty were successfully performed with excellent cosmetic results and no complications.

Laparoendoscopic single-site surgery for pediatric patients in urology.

Purpose of review Laparoendoscopic single-site surgery (LESS) has been increasingly reported to be a new less invasive approach. In the field of pediatric urology, in which even the application of laparoscopic surgery is still limited, recent studies are reviewed and the operative method and results evaluated. Recent findings Nephrectomy, nephroureterectomy and partial nephrectomy have been reported in renal surgery. Varicocelectomy, orchidectomy and orchidopexy have been performed for intrascrotal diseases. The postoperative complication of hematoma was observed in one bilateral case out of three nephrectomies, and blood transfusion and percutaneous drainage were needed. Postoperatively, two male patients out of 11 nephrectomy cases developed unilateral ipsilateral hydroceles. A surgical repair of the hydrocele was performed in a 3.9-year-old boy. Summary LESS for pediatric patients in urology is feasible but has just begun, and the number of cases experienced is still small. Further clinical evaluation including a large-scale study and comparison with standard laparoscopic surgery will reveal the true efficacy of this novel procedure.

Laparoendoscopic single-site versus conventional laparoscopic pyeloplasty: a matched pair analysis.

To compare the outcomes of laparoendoscopic single‐site pyeloplasty versus those of conventional laparoscopic pyeloplasty.

Significant Antitumor Effect of Intratumoral Ethanol Injection on Renal Cell Carcinoma

OBJECTIVE The effects of intratumoral ethanol injection on renal cell carcinoma (RCC) heterotransplanted in nude rats were evaluated. MATERIALS AND METHODS The OUR95AF human RCC cell line was inoculated subcutaneously into the backs of nude rats. Four weeks after transplantation, the size of tumors became 1.5-2.0 cm in maximal length, and 95% ethanol was injected intratumorally once a week for five weeks. The effectiveness of this treatment was evaluated by measurement of tumor volume, magnetic resonance (MR) imaging using Gadopentetate-diethylenetriaminepentaacetic acid (Gd-DTPA) and histological examinations. RESULTS In the ethanol injected group, no increase in tumor volume was recognized. The growth of the tumors was significantly suppressed after the third injection. Non-enhanced parts in MR imaging were observed in the central region of the tumors at the second injection, and increased at the third injection. After the fifth injection, only small parts of non-enhanced regions remained. Degenerative necrosis was histologically found in the non-enhanced parts of the MR image. The signal to noise ratio (SNR) and the contrast to noise ratio (CNR) calculated from T1 weighted imaging using Gd-DTPA, and relative enhancement (RE) were thought to be good parameters for evaluating the effect of ethanol injections. CONCLUSION Intratumoral ethanol injection was very effective against RCC. Five weekly injections of ethanol induced necrosis of the tumor. MR imaging using Gd-DTPA may be a useful method for evaluating the effect of ethanol injection.

Laparoendoscopic single-site surgeries: A multicenter experience of 469 cases in Japan

To report on a multi‐institutional series of non‐robotic urological laparoendoscopic single‐site surgery in Japan.